Intraoperative Transesophageal Echocardiography in Acute Type A Aortic Dissection: Contemporary Approach
Marta Kelava, Andrej Alfirevic, Mariya Geube, Andrew M. Bauer, Nikolaos J. Skubas, Luai Zakaria, Eric E. Roselli, Patrick R. Vargo, Faisal G. Bakaeen, Xiaoying Lou, Lars G. Svensson, Marijan Koprivanac
Abstract
Acute type A aortic dissection represents a critical cardiac surgical emergency and carries a significant mortality risk. While computed tomography angiography is the standard for initial diagnosis, transesophageal echocardiography (TEE) is indispensable in the intraoperative setting. This article discusses intraoperative TEE findings in patients undergoing surgery for type A aortic dissection, emphasizing the necessity of real-time imaging to detect complications and guide surgical management. The use of TEE is important in confirming diagnoses, monitoring hemodynamics, evaluating the function of the aortic valve, pericardial, and pleural spaces, and potentially assessing abdominal branch vessel flow, thus ultimately facilitating informed surgical decisions. Moreover, intraoperative TEE use enables differentiation between true and false lumens and facilitates central aortic cannulation guidance via the Seldinger technique. Post-cardiopulmonary bypass, TEE is used to assess surgical results and guide further interventions if necessary. This comprehensive review aims to disseminate essential echocardiographic insights, advocating for greater awareness and utilization of TEE in the surgical management of aortic dissection to improve patient outcomes.